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When Is It Time for Parents to Consider Inpatient Teen Depression Treatment?

Written by Evolve's Behavioral Health Content Team​:

Alyson Orcena, LMFT, Melissa Vallas, MD, Shikha Verma, MD, Ellen Bloch, LCSW, Lianne Tendler, LMFT, Megan Johnston, LMFT

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Professional Help for Teenage Depression: A Life-Changing Choice

We’ll open this article by answering the question posed in the title right away. Then we’ll explain the steps you need to take – or may have taken already – before considering or committing to inpatient teen depression treatment.

We won’t make you read through the supporting details first. But in order to understand the answer, we think you should read the rest of the article. That’s how you’ll know you’re making the right choice – and you’ll also know why you’re making that choice.

Hint: we inform our answer with data collected over the past fifty years and the expert opinion of mental health professionals with decades of experience supporting teens in youth residential treatment centers around the country.

Here’s the answer:

It’s time to consider inpatient teen depression treatment – meaning either residential treatment or psychiatric hospitalization –  when the symptoms of depression prevent or significantly impair your teen’s ability to participate in the daily activities related to life at home, school, work, during extracurricular activities, or with peers.

That may be all you want to know right now. If that’s the case, then please navigate to this page and download our helpful publication, A Parent’s Guide to Mental Health Treatment for Teens. We wrote the guide to help parents navigate the potentially confusing and often overwhelming process of finding appropriate treatment for teens with mental health disorders, including but not limited to major depressive disorder (MDE).

That’s the clinical term for depression, in case you didn’t know that already.

What we’ll do now is unpack the definition we offer above. First, we’ll outline the symptoms of depression, so you can watch for them and determine whether they have an impact on your teen’s daily life. Then we’ll talk about the criteria mental health professionals use to determine what level of care your teen might need, share the latest statistics on teen depression, and end with a brief note about how and why professional treatment is essential for teens diagnosed with a depressive disorder.

How to Help Your Teen With Depression: Know the Symptoms

The authors of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) coined the clinical term we identified above: major depressive disorder (MDD). They define MDD as “…an overwhelming feeling of sadness, isolation, and despair that last two weeks or longer at a time.”

If you suspect your teen needs inpatient teen depression treatment, your first step is to know about and watch for the items on the following list.

Depression in Teens: Signs and Symptoms

  1. Persistent/daily sadness
  2. Persistent/daily crying
  3. Continuous low mood
  4. Feelings of hopelessness or pessimism every day
  5. Anger/hostility
  6. Persistent/daily irritability
  7. Feelings of worthlessness every day
  8. Absence of interest in formerly loved or favorite hobbies, pastimes, or activities
  9. Chronic tiredness/fatigue
  10. Self-isolation
  11. Withdrawal from friends and/or family
  12. Problems communicating with friends and/or family
  13. Constant boredom/restlessness
  14. Problems with concentration, memory, and/or decision-making
  15. Sleep problems: too little or too much
  16. Sudden weight loss/gain
  17. Frequent headaches or stomachaches that don’t have a clear cause and don’t respond to typical remedies
  18. Thoughts, talk, or behavior related to suicide*

*IMPORTANT NOTE: If you think your teen is in immediate danger or poses an imminent threat to themselves or someone else, call 911 immediately or take them to an emergency room at a regular hospital or a psychiatric hospital.

As you read that list, we know what you may think. Teens show those symptoms all the time. Teens are intermittently moody, cranky, and irritable by nature. As far as you know, that’s part of being a teenager. Some appear perfectly well-adjusted, but most display the symptoms above – and more than just sometimes.

But more than just sometimes is not clinical criteria for MDD. In order to meet the threshold for clinical MDD, a teen must display at least two of the major symptom groups above (low/sad mood and loss of interest/pleasure) every day for a minimum of two consecutive weeks. They must also display at least five of the symptoms, total, during the same two-week period.

That’s different than a cranky, tired teen on Tuesday who gets it together and fires on all cylinders by Wednesday night. If that’s your teen, then they probably don’t need inpatient treatment. With that said, we cannot diagnose your teen or recommend a course of treatment.

Only a mental health professional can do that.

With that said, what you see above are the signs and symptoms of teen depression. They’re followed by the criteria professionals use to arrive at an initial diagnosis, based on the symptoms they observe or your teen reports.

However, there’s more to know – and that’s your second step.

Depression in Teens: Mild, Moderate, or Severe

When clinicians diagnose depression, they also determine what type of depression the symptoms indicate, and the level of disruption, difficulty, and challenge those symptoms cause. Based on the level of disruption, difficulty, and challenge, clinicians label depression as mild, moderate, or severe. Then, they base their treatment recommendation by considering the type of depression and the acuity (level of immediate seriousness) of the symptoms.

Here are the most common types of depression:

  1. Major depressive disorder (MDD). This is the type of depression we discuss above.
  2. Seasonal affective disorder (SAD). This type of depression occurs in response to the seasons. It’s commonly associated with winter, but SAD can happen in the summer, as well.
  3. Persistent depressive disorder (PDD). This is similar to MDD, but the criteria differ, as follows: “…depressed mood for most of the day, more day than not, for at least two years in adults and one year in children or adolescents.”
  4. Subtypes of depression. The words themselves describe the distinguishing features:
    • Anxious
    • Melancholic
    • Catatonic
    • Atypical
    • Alcohol/substance-use related

Now let’s address what makes a depressive disorder mild, moderate, or severe.

Mild

A mild depressive disorder is characterized by experiencing the symptoms listed above more days than not. They’re difficult, uncomfortable, emotionally challenging, and may interfere with your teen’s day-to-day living, but do not prevent them from participating in family, school, work, or social life.

In most cases, a mental health professional will not refer a teen with mild depression for inpatient treatment. Instead, they will probably refer them to an outpatient, intensive outpatient, or a partial hospitalization program.

Moderate

A moderate depressive disorder is also characterized by experiencing the symptoms listed above more days than not. They’re more difficult, more uncomfortable, more emotionally challenging, and more disruptive than mild symptoms. In many cases, moderate symptoms may impair your teen’s ability to participate in family, school, work, or social life.

In some cases, depending on the level of impairment, a mental health professional may refer a teen with mild depression for the type of inpatient treatment known as residential treatment, which occurs in residential treatment centers (RTCs) for teen depression.

Severe

A severe depressive disorder is characterized by experiencing the symptoms listed above every day for at least two weeks, but in many cases, they occur every day for six months or more. In addition, the symptoms are far more difficult, more uncomfortable, more emotionally challenging, and more disruptive than mild or moderate symptoms. Severe depressive symptoms may completely prevent your teen’s ability to participate in family, school, work, or social life. Severe depressive symptoms can make it almost impossible to do anything – even get out of bed, eat, or carry out the basic necessities of personal hygiene. Teens with severe depression are at higher risk of suicide than teens with mild or moderate depression.

In most cases, a mental health professional will refer a teen with severe depression to one of two types of inpatient treatment for teen depression: residential treatment or inpatient psychiatric hospitalization.

We’ll discuss residential treatment and inpatient hospitalization now, starting with inpatient hospitalization. Understanding those differences is your third step in deciding whether it’s time to consider inpatient treatment for your teen with depression.

Inpatient Hospitalization Treatment for Teen Depression

We’ll cut to the chase here, too, the way we did in the opening of this article.

We’ve mentioned there are two types of inpatient depression treatment for teens: residential treatment, which occurs in residential treatment centers (RTCs) for teens, and inpatient hospitalization, which occurs in the psychiatric wing of a general hospital or in a specialized psychiatric hospital.

Here’s how we cut to the chase:

Inpatient hospitalization is for teens who are in immediate crisis and pose an imminent threat or risk to the health and safety of themselves or others. Teens who are suicidal, engage in suicidal ideation, engage in escalating self-harm, or display a pattern of escalating risky and dangerous behavior related to their symptoms may receive a referral for inpatient psychiatric hospitalization.

We’ll say it again: inpatient hospitalization is for teens in crisis. The goals of this level of care are safety and stabilization. That’s why a stay in an inpatient psychiatric facility – as opposed to a residential treatment center – is typically short, lasting from three to ten days, on average. If a psychiatrist refers your teen to inpatient hospitalization, the medical staff at the hospital will discharge your teen when they’re capable of fully participating in therapy and recovery activities. In most cases, a teen in crisis is not capable of participating in therapy or recovery activities. They may need the intensive immersion of a hospital stay until their crisis passes.

Residential Treatment for Teen Depression

Residential treatment, on the other hand, is different. It’s not for teens at imminent risk of harm, but it is for teens with depressive symptoms so severe they prevent them from participating in almost all aspects of daily life and living at home.

Technically speaking, residential treatment is a form of inpatient treatment – since inpatient means staying overnight at the treatment facility – but the focus and primary goals of residential treatment are broader in scope than the focus and goals of inpatient hospitalization.

Whereas the goals of hospitalization are safety and stability, the goals of residential treatment are all about therapy and recovery. During residential treatment, clinicians will help your teen identify and discuss their emotions, validate their experiences, and understand the relationship between their emotions, thoughts, and behaviors. Then, they help your teen use the new knowledge to develop proactive coping skills that allow them to process difficult emotions and manage stress in healthy, productive ways.

In a residential treatment program, your teen will likely participate in some, but not all, of the following types of therapy and/or activities.

Common Elements of Residential Depression Treatment for Teens

  • Individual therapy:
  • Group therapy:
    • CBT groups
    • DBT groups
  • Family therapy:
    • Family + teen groups
    • Multi-family groups (with teens)
    • Parenting groups (without teens)
  • Mindfulness-based stress reduction:
    • Meditation
    • Yoga
    • Mindful walking
  • Experiential therapies:
    • General exercise
    • Surfing
    • Equine therapy (horses)
    • Hiking
    • Boxing
  • Expressive therapies:
    • Art therapy
    • Creative writing
    • Music
    • Dance
    • Drama
  • Medication (if necessary)

If your teen has severe depression – as diagnosed by a mental health professional after a full evaluation – and they receive a referral for either inpatient hospitalization or residential treatment, you now have a good idea what they both entail. You can use the information in this article to inform your decision, ask your teen’s therapist good questions, and participate more fully in the collaboration necessary to create a viable treatment plan for your teen and get them on the road to recovery.

The Benefits of Treatment

In addition to everything we mention above, another thing your teen will gain from treatment is empowerment. Your teen may be in crisis right now and need hospitalization. That’s hard – and we get it. However, evidence shows that treatment works. Teens move from hospitalization to residential treatment to the lower levels of care and then move home – and they do it day in and day out, all over the country. The process itself teaches teens they can go from a place where they feel hopeless and powerless to a place where they feel hopeful and empowered.

That’s an important life lesson they’ll keep with them for the rest of their lives.

The skills they learn in treatment can serve them well, if they commit to the process and do the hard work involved in growth and healing. You’ll learn and grow, too, as a parent. Together, you can restore balance to your lives and rebuild your family life.

We know, because we help teens and their families do it every day.

Finding Help: Resources

If you’re seeking treatment for your teen, the American Academy of Child and Adolescent Psychiatry (AACAP) is an excellent resource for locating licensed and qualified psychiatrists, therapists, and counselors in your area. Both the National Institute of Mental Health (NIMH) and the National Alliance on Mental Illness also provide and high-quality online resources, ready and waiting for you right now.

Our Behavioral Health Content Team

We are an expert team of behavioral health professionals who are united in our commitment to adolescent recovery and well-being.

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